Health Information Technologies

Advanced Information Technology Group (AITG) serves as the Military Health System's research arm for emerging and enabling healthcare information technologies and advanced clinical informatics. It manages a portfolio of about 50 Congressional Special Interest (SCI), Small Business Innovative Research (SBIR), and TATRC augmentation funded projects which are typically awarded as grants or cooperative agreements.

Typical research projects involve new human-computer interfaces; clinical decision support algorithms and alerts in electronic health records; revolutionary clinical intelligence tools to facilitate quality assurance studies and clinical research; personal health records; mobile health technologies; new data mart storage technologies; virtualization, cloud, and grid computing; service oriented architectures; terminology and ontology mediation; open healthcare standards and tools; and semantic health information exchange.

HIT is a hot topic these days, but the question remains whether it can produce real value to the healthcare delivery system. TATRC oversees research to determine how well these technologies can transform health data into information, knowledge, understanding, and wisdom, and to help improve healthcare access, availability, acceptability, cost-effectiveness, continuity, and quality. Many of the projects have the potential to help acquire or access data, analyze or execute data, distribute data, or archive and retrieve data. All are being executed with national and international standards and open source technologies to the maximum extent possible.

If proven to have value, TATRC works with the Military Health System Defense Health Information Management System (DHIMS) and Defense Health Services Support (DHSS) Program Offices to transfer these technologies into production.

Many of these opportunities are being leveraged, with the concurrence of grant and cooperative agreement recipients, to strengthen existing services, or to build new services in the Nationwide Health Information Network (NHIN), using open source technologies.

The National Health Information Network

Desirable "Candidate" Services

Example Projects:

Connecting Relay Health to the Nationwide Health Information Network (NHIN) Prototype:

As part of a Congressional Special Interest Project, Hospital of the Future, awarded to Spartanburg Regional Health System, SC, TATRC partnered with RelayHealth, Inc. to connect RelayHealth's secure messaging and personal health record platform to a prototype Nationwide Health Information Network (NHIN) CONNECT Gateway. The partnership was an opportunity that became possible because Spartanburg Regional Health System uses the McKesson Electronic Health Record in their facility, and wanted to explore use of the RelayHealth services. RelayHealth, Inc., a subsidiary of McKesson, Inc., pioneered online healthcare communications to improve the delivery and accessibility of healthcare. It provides connectivity that allows physicians to communicate with their patients, efficiently, affordably, and securely. The Nationwide Health Information Network (NHIN) is being built to provide a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers, and others involved in supporting health and healthcare. The NHIN will enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond direct patient care so as to improve health. RelayHealth service was also integrated into the McKesson EHR at Spartanburg Regional Health System. If brought to production, RelayHealth would become a "citizen of the NHIN", and its secure messaging and Personal Health Record services could be available nationally.

Congressional Special Interest Project, Healthwise, Inc., Development of HL-7 Info Button Services in Nationwide Health Information Network (NHIN)

TATRC is overseeing a Congressional Special Interest project awarded to Healthwise, Inc., whose nonprofit mission is to help people make better health decisions. Healthwise, Inc. provides patient education material under a concept known as Information Therapy (Ix®). With Healthwise Information Therapy, hospitals, health plans, and disease management companies can give consumers the right information at just the right time, to help them make better health decisions. Healthwise, Inc. believes that information is powerful as any test, medication, or surgery, and that without it, medical care is incomplete. Under the Congressional Special Interest Project, Healthwise, Inc. is working to place Health Level Seven (HL-7) Info Button Standard services into the Nationwide Health Information Network (NHIN) in an open source manner. The implementation will allow clinicians to request patient information from HealthWise, Inc., or other content vendors, or to attach such material to a document transiting the NHIN.

Congressional Special Interest Project, TRICARE Health Information Exchange, (THIE), Pensacola, Florida

This project established a TRICARE Health Information Exchange (THIE) in Pensacola, Florida to share protected health information (PHI) between Sacred Heart Healthcare System and Naval Hospital Pensacola. The HIE is made possible through the implementation of Cogon Systems Virtual Health Network (VHN), which is linked to the DoD/VHA Bi-Directional Health Information Exchange (BHIE). The following data set can currently be accessed transiently by military and civilian providers via web services:

A patient identity management scheme was stood up in order to correlate Cogon's master patient index with that of the BHIE platform. New patient records are 'announced' to the BHIE where a cross-correlation establishes whether those patients a concomitant military health record.

PHI data exchange began on 12 June 2009. As of June 22nd, 46,752 civilian records were announced to the BHIE platform with 6,144 records having a cross-correlation to MHS record. An economist will measure the impact of the exchange on avoiding otherwise duplicate tests which would be ordered in lieu of an operating exchange.

In collaboration with the Pensacola Bay Chamber of Commerce, Strategic Health Intelligence, LLC (SHI) was established with the involvement of major civilian healthcare providers and Naval Hospital in Pensacola. The intent of the SHI is foster health innovation and to sustain the health information exchange in Pensacola as a public utility.

Although this project has been successful, it provides a point-to-point exchange between a DoD facility and a civilian healthcare facility which will be avoided in the future due to cost maintenance issues. In the future, DoD and VHA facilities will employ the NHIN Connect Gateway to connect to the NHIN, and exchange information with civilian facilities via the NHIN.

Congressional Special Interest Project, INRange, Inc., TelePharmacy Robotic Medication Delivery Unit (TMRDU)

TATRC is overseeing a Congressional Special Interest project to pilot test a Remote Medication Management Device at a Naval Hospital, Camp Pendleton, California, Ireland Army Community Hospital, Fort Knox, and VHA Tampa. The device is already implemented in transient units at the Walter Reed Army Medical Treatment Facility. Commercially, the product is known as EMMA. The device is intended to improve medication administration. Past research suggest that 60% of patients do not adhere to their prescribed medications for multiple reasons. This project will determine if EMMA can improve patient adherence to taking prescribed medication.

The EMMA® system consists of a Medication Delivery Unit (MDU) and wireless two-way web-based communications software that allows a physician, pharmacist or other licensed practitioner to remotely manage prescriptions stored and released by the patient-operated MDU. The patient's prescriptions and refills are packaged in standard-sized blister cards which are dispensed to the patient in place of an amber bottle filled with pills. Each MDU can hold up to ten (10) blister cards (multiple blister cards may be connected together) that are loaded into the MDU much like CD's are loaded into a car or home stereo. The MDU identifies each medication automatically - no patient input is required. Changes made to the dosing instructions are transmitted to the MDU - no home nursing visit or physician phone instructions are needed.

When it is time for the patient to take their medications, the MDU emits an audible and visual alert to the patient. When activated by the patient, the medications are selected from the blister cards and released into the delivery tray.

EMMA is the first and only device cleared by the FDA for use in Remote Medication Management. EMMA is programmed by a pharmacist or other licensed professional remotely from their pharmacy or office. EMMA then delivers the medications to the patient or a caregiver without the need for a licensed professional to verify that each dose is correct.